Dissemination and Implementation of Age-Friendly Care and Geriatric Emergency Department Accreditation at Veterans Affairs Hospitals

ABSTRACT

Study Objectives: In 2018, the US Department of Veterans Affairs (VA) Offices of Emergency Medicine and Geriatrics & Extended Care partnered to improve acute, unscheduled care for older Veterans. The goals of the partnership were to create a VA core team to promote best geriatric emergency care practices via standardization, education, and Geriatric Emergency Department (ED) Accreditation (GEDA) through the American College of Emergency Physicians. The objective of this will be to describe the current progress of GED implementation and dissemination at the VA. Study Design / Methods: This is a descriptive summary of Veterans seen in VA EDs from January 2018 - March 2022 with data from the VA Corporate Data Warehouse. We collected GED implementation data by extracting rates of screening for documented geriatric assessments, health care utilization patterns, and demographic data from ED visits. We compared EDs with and without GED implementation (non-GED versus Level 3 to 1 (L1 = highest GEDA implementation)) based on date of accreditation [RLCD1] application submission or approval. Standardized GED assessments in the electronic health record did not begin until 2019[RLCD2], although some sites collected local data on GED programming in 2018. Results / Findings: During this implementation phase, 1.07 million unique Veterans 65+ years in age made 4.08 million VA ED visits. Over 40% of these visits were made atoccurred in a VA ED seeking or receiving GEDA. Forty percent of VA EDs (44/111) began GED initiatives and applied for or received GED accreditation (4 as Level 1, 7 as Level 2, and 33 as Level 3);28 (25%[MCM((3] [RLCD4] ) of VA ED are now GED accredited. The nationally standardized GED assessments include the Identification of Seniors At Risk (ISAR), Delirium Triage Screen (DTS), Brief Confusion Assessment Method, Mini-Cognitive assessment, a falls risk screen, Activities of Daily Living, and Caregiver Burden screen. The most heavily adopted screens completed in GEDs were the ISAR and DTS. ISAR screening documentation continuously increased, especially at Level 1 GEDs, (from 0% in 2018 to 57.5% of Veterans screened in 2022). The DTS screening documentation also increased at Level 1 GEDs (from 0% in 2018 and 2019 to 23.7% in 2022). There were no differences by admission rates when comparing Level 1 GEDs versus non-GEDs (27.9% vs. 27.3%;p=0.18). GEDs, however, had lower ED revisit rates at 24 hours (1.5% vs. 2.1%), 72 hours (4.0% vs. 5.3%), 30 days (23.3% vs. 25.1%), and 90 days (33.8% vs. 36.3%) compared to non-GEDs (all p<0.01) [RLCD5]. Conclusion(s) The VA is the country's largest integrated health care system implementing and disseminating geriatric emergency care. Adoption of geriatric-focused screenings has steadily increased over time as more facilities pursue GEDA. With 40% of its EDs seeking GED accreditation, and 25% sites achieving this (during the COVID pandemic), the VA approach to implementation and spread of geriatric emergency care can be a model for other health care systems. No, authors do not have interests to disclose Copyright © 2022